Do you typically recommend placement of a rectal spacer prior to definitive radiotherapy, regardless of dose/fractionation?

In my opinion, the potential and role of rectal spacing in minimizing toxicity is not debated. The concern about spacing relates to risks of the procedure and its associated additional cost to treatment may be greater than the potential improvement in toxicity for the patient. As we continue to show that dose escalation improves clinical outcome, and the increasing trends towards focal dose escalation through micro boosts across all fractionation approaches. I believe the importance of hydrogel ...

In theory, it makes sense. In reality, in my experience, it should be placed by a well-trained, experienced urologist. Achieving spacer uniformity from patient to patient is an issue.

Overall experience has been fair. My personal results have been erratic with regard to gel placement.